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  • Acts
  • 2005
  • Chapter 175 AN ACT PROVIDING EMERGENCY PRESCRIPTION DRUG COVERAGE FOR SENIORS AND THE DISABLED.

Whereas , The deferred operation of this act would tend to defeat its purpose, which is forthwith to provide emergency drug coverage for seniors and the disabled, therefore it is hereby declared to be an emergency law, necessary for the immediate preservation of the public health and convenience.


Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:


SECTION 1. Section 1 of chapter 176K of the General Laws, as appearing in the 2004 Official Edition, is hereby amended by inserting after the definition of "Medicare" the following definition:-

"Medicare Part D", Medicare prescription drug coverage available to Medicare-eligible persons beginning January 1, 2006, as authorized under the federal Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

SECTION 2. Subsection (c) of section 4 of said chapter 176K, as so appearing, is hereby amended by adding the following paragraph:-

Consistent with the implementation of Medicare Part D, no carrier that participates in the market shall offer any Medicare supplement insurance plans with prescription drug coverage. All Medicare supplement insurance plans with prescription drug coverage shall be closed to new enrollments, but shall be kept guaranteed renewable. A person enrolled in a Medicare supplement insurance plan with prescription drug coverage and who enrolls in Medicare Part D shall be transferred to that person's carrier's most comparable Medicare supplement insurance plan without prescription drug coverage, unless that person chooses coverage under any of that carrier's other Medicare supplement insurance plans without prescription drug coverage. The coverage provided by such comparable plan shall become effective when the Medicare Part D coverage becomes effective. The rate for such comparable plan shall be the same rate that is in effect at the time of the transfer. The carrier shall notify all persons affected by this change and shall describe to those persons all the reasons for the respective coverage and rate changes.

SECTION 3. Notwithstanding any general or special law to the contrary, the secretary of health and human services shall design a financial wrap-around program for eligible persons under section 39 of chapter 19A of the General Laws, who are also eligible for prescription drug coverage under the federal Medicare Prescription Drug, Improvement, and Modernization Act of 2003 or its successor legislation. This wrap-around program shall ensure that no such person shall have out-of-pocket costs for a drug covered by his Medicare prescription drug plan that is higher than what he would be responsible for under said section 39 of said chapter 19A, or regulations under that section, if he were not eligible for Medicare prescription drug coverage. This program shall not apply to individuals with incomes at or greater than 500 per cent of the federal poverty level.

SECTION 4. Notwithstanding any general or special law to the contrary, the subsidized catastrophic prescription drug insurance program established in section 39 of chapter 19A of the General Laws shall provide coverage for a 1-time, 30-day supply of medications between January 1 and June 30, 2006 to enrollees under this section who are also eligible for Medicare prescription drug coverage. This coverage shall not apply if the enrollee's Medicare prescription drug plan will cover the prescribed medication at the time the prescription is presented. The coverage for each medication shall be subject to the same cost sharing arrangement applicable under the enrollee's Medicare prescription drug plan. For each subsequent medication which is not covered under the enrollee's Medicare prescription drug plan, the program shall provide coverage for a 1-time, 72-hour supply of such medication.

SECTION 5. Notwithstanding any general or special law to the contrary, the secretary of health and human services, in consultation with the director of Medicaid, shall authorize MassHealth payment for a 1-time, 30-day supply of prescribed medications between January 1 and June 30, 2006 for beneficiaries under chapter 118E of the General Laws who are also eligible for Medicare prescription drug coverage. This payment shall be authorized only if the beneficiary's Medicare prescription drug plan will not cover the prescribed medication at the time the prescription is presented. Any co-pays or deductibles that would have been charged to the beneficiary under MassHealth shall apply to this 1-time, 30-day supply during 2006. For each subsequent medication which is not covered under the enrollee's Medicare prescription drug plan, MassHealth shall provide coverage for a 1-time, 72-hour supply of such medication.

SECTION 6. Notwithstanding any general or special law to the contrary, the secretary of health and human services, in consultation with the director of Medicaid, shall authorize MassHealth payments to reduce prescription drug copayments to MassHealth levels for any MassHealth member who is enrolled in a Medicare prescription drug plan that charges the member a copayment in excess of the applicable MassHealth copayment.

SECTION 7. The secretary of health and human services, in consultation with the secretary of elder affairs and the director of Medicaid, shall supply pharmacists with clear, concise and consumer-friendly information to accompany 1-time, 30-day or 72-hour supplies of medication made to Medicare enrollees at state cost pursuant to sections 2 and 3. This information shall be in at least 2 languages, shall explain that MassHealth and Prescription Advantage shall no longer cover the prescribed medication, shall explain the actions the consumer may take to secure access to that medication or a clinically-appropriate alternative and shall include appropriate toll-free numbers to call for more information.

SECTION 8. Section 2 shall take effect on January 1, 2006.

Approved December 30, 2005.